Background: Preoperative skin preparation is performed differently by different operating room nurses. Aim: To deepen the understanding of skin preparation within an orthopaedic surgical setting from the operating room nurse perspective and to explore their experiences. Methods: A qualitative exploratory design was used. Four focus group interviews were conducted during 2016-2017, at four hospitals in Sweden, using procedures developed by Krueger and Casey. A total of 19 operating room nurses were recruited through purposive sampling. Results: Statements were categorized into four categories of experiences: (1) Knowing, which related to learning and sources of knowledge; (2) Doing, which related to skin preparation and activities based on tradition and evidence; (3) The Team, which related to the assignment of responsibility and collaboration with patients and other professions; and (4) The Setting, which related to factors around the patient and included feelings of time pressure and access to supplies. Conclusions: Theory and practice differ, and some skin preparation used are based on tradition rather than on evidence or recommendations. Elements both within the team in the operating room and within the organization influence the result. Operating room nurses' duty to perform safe skin preparation must be respected in the team.
Preoperative skin preparations may reduce the risk of hospital-acquired infections. This cross sectional questionnaire study aimed to identify the practice and knowledge of preoperative skin preparation in Swedish orthopaedic surgery departments. One hundred and six respondents (response rate 68%) from 13 Swedish orthopaedic departments reported a diversity of current recommendations and evidence, and good knowledge of skin preparations. This study found variations in practice and deviations from recommendations, despite high levels of knowledge.
Background Surgical site infections pose a significant threat to patient safety, causing morbidity and mortality. Preventing surgical site infections through infection prevention interventions during surgery is crucial in limiting the risk of contamination from environmental microorganisms or skin flora. In many countries, operating room nurses are responsible for the aseptic environment and the performing of preventive interventions during the intraoperative phase. For patient safety, optimal prerequisites should be present for the operating room nurses’ performance of infection prevention interventions. This integrative review was conducted to explore the prerequisites for operating room nurses to effectively carry out infection prevention interventions during the intraoperative phase. Method Whittemore and Knafl´s review method guided this integrative review. The search strategy includes multiple academic databases, backward and forward chaining, and targeted internet searches. The constant comparative method was used to analyse and synthesise data from 17 studies. Results This review identified several key factors that affect operating room nurses' ability to perform safe infection prevention interventions. These factors included intrapersonal prerequisites of the operating room nurses, interpersonal prerequisites within the operating room team, external conditions, and both facilitating prerequisites and barriers to implementing evidence-based practice. The intrapersonal category emerges from the subcategories: have control, planning ahead, competency, and occupational stress. The interpersonal category originates from the subcategories: cooperative behaviour and respect. The conditions category emerges from the subcategories: management and communication systems. The evidence-based practice category includes prerequisites for the use of scientific evidence. Conclusions This study highlights the need to improve the prerequisites to effectively execute safe preventive infection interventions. The team's lack of commitment to preventing surgical site infections raises concerns for patient safety and leaves operating room nurses feeling disrespected. Operating room nurses should assume leadership responsibilities and be supported by management, with access to necessary prerequisites such as information, education, and sufficient time for preparation and implementation. Regular feedback on infection rates and complications is crucial. The study highlights the significance of well-staffed and familiar teams and the urgency of zero tolerance for abusive behaviour. Resilience is essential for operating room nurses' well-being and optimal patient care.
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